NHS reforms are obstructing the push for efficiency gains, say MPsBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e579 (Published 24 January 2012) Cite this as: BMJ 2012;344:e579
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Written evidence of short-term expediency by some primary care trusts (PCTs) to produce savings in their continuing healthcare (CHC) budgets was provided to the Health Committee by the Alzheimer’s Society, Motor Neuron Disease Association and Age UK. [1,2] People with dementia were being reassessed for funding “with greater promptness” and losing funding even when the condition was deteriorating.
Similarly, the MND Association gave examples of funding being wrongly taken away because needs were being well managed, only later to have such funding decisions reversed. Such short-term expediency saw costs shift from PCTs to social services while vulnerable people were “bounced” between NHS and social care funding.
In its evidence, Age UK wrote that there were substantial reductions in CHC funding in some areas by up to 70% in one year with people losing their NHS funding. In Age UK’s opinion, some PCTs were “looking at ways to restrict eligibility to reduce cost rather than seeking new ways of working.”
It would seem that some PCTs are ignoring the lawful limits of social care funding as established by the Coughlan case in 1999. Ms Coughlan’s needs were of a wholly different kind to those that could be lawfully provided by a local authority. The pen picture of Pamela Coughlan, as documented on pages 103 and 104 of the Spinal Injuries Association Continuing Healthcare Information Pack, shows someone with relatively modest health and nursing needs. 
A generous assessment and documentation of needs using the Department of Health’s 2009 decision support tool, taking into account the risk of harm from autonomic dysreflexia if injury occurred while in her powered chair, would show Ms Coughlan as having just one severe level, two moderate levels and four low levels of needs severity across the 12 care domains (Figure 1). Anyone with an intensity of need, as demonstrated by the spread and severity of scores, similar to Ms Coughlan should be eligible for NHS CHC funding.
PCTs would seem to be acting unlawfully by refusing funding in eligible cases and making cuts in their CHC funding budgets. Local authorities are acting unlawfully by failing to challenge PCT decisions. They are taking on people with nursing and health needs that are more than just merely ancillary and incidental to the accommodation provided and who in reality are people with needs well beyond those that a council can lawfully provide.
Why did Health Committee MPs fail to specifically comment on this evidence from the three charities highlighting cuts by PCTs in CHC funding?
 Campbell D. NHS reforms are obstructing the push for efficiency gains, says MPs. BMJ 2012;344:e579
 House of Commons Health Committee. 13th Report – Public Expenditure – Volume II. www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1499/1499vw...
 Spinal Injuries Association. Continuing Healthcare Information Pack (revised December 2010) www.spinal.co.uk/userfiles/images/uploaded/pdf/291-648445.pdf
Competing interests: Challenging CHC funding decision by a PCT.